HomeMy WebLinkAboutFilled Land Affidavit 1
_ PLANNING&DEVELOPMENT SERVICES DEPARTMENT
' Building&Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE,FL 34982-5652
(772)462-1553
FILLED LAND AFFIDAVIT
I,the undersigned, am the owner of the following described property,
012.E A,eOZ4�
(Parcel Id#/Legal description/Address)
for which I have applied to St. Lucie County for a Final Developmnt Permit. In
accepting this Final Development Permit, BP Number ® Z acknowledge
that as owner of the above described property, and in accordance with Section
7.04.01(D), St. Lucie County Land Development Code, I shall be responsible for assuring
adequate drainage so that the immediate community WILL NOT be adversely affected.
I further acknowledge that in granting this permit for the development of this property,
St. Lucie County is neither obliged nor liable to provide for, or maintain in any form,
adequate drainage off my property which will not adversely affect the immediate
community.
Pal
Property Owner Name(Please Print)
Property Owner Signature Date
STATE OF FLORIDA,COUNTY OF u
ACKNOWLEDGED BEFORE ME THIS ` / DAY OF �/ 20_Ze_P
BY PrAni.0 IPg -��e-V',�O✓1 k I _WHO IS PERSONALLY KNOWN TO ME C OR WHO HAS
PRODUCED PA �I Q LI D I L0 ®' AS IDENTIFICATION.
W1P i I SSG int'h h i,�duh.
SIGNAT OF N IC TYPE NOTARY
Z 2 COMMISSION NUMBER
(SEAL) ;;t•"Y"w,'•; MELISSA DENNISTON
•`�'"= Notary Public-State of Florida
. • .;
• Commission q GG 122579
My Comm.Expires Sep 24,2019
SLCPDSD Revised 04/11/2011